Resolution Foundation C medical aid plan: 2017

Pay for all children. Income-limited plan: R7,101-R9,700pm only

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IN HOSPITAL PROCEDURES:
Payout Rate for Specialists:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,338 R1,338 R427
Children: Pay for all children
Income limit: R7,101-R9,700 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:
Hospital Choice:
  • Network or R3,896 co-payment
Specialised Radiology:
Supplementary Services: (Physio, etc)
Transplants:
Co-payments:
    Co-payments might apply, depending on scheme protocols and alternative available treatment
Alternatives to hospitals:
  • Home nursing: no benefit, unless in lieu of hospitalisation

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OUT OF HOSPITAL BENEFITS:
GP consultations:
  • Network GP: Unlimited
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,338 R1,338 R427
Children: Pay for all children
Income limit: R7,101-R9,700 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Specialists consultations:
  • No benefit, unless PMB
Pathology:
  • No benefit, unless PMB
General radiology:
  • No benefit, unless PMB
Specialised radiology:
  • No benefit, unless PMB
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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MATERNITY BENEFITS:
Hospital stay:
  • Vaginal birth: 3 days, 2 nights
  • Caesarean birth: 4 days, 3 nights
  • Elective Caesarean: no benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,338 R1,338 R427
Children: Pay for all children
Income limit: R7,101-R9,700 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Consultations:
  • Consults by GP or midwife only. Specialists require authorisation
  • Antenatal classes: no benefit
Scans:
  • 2 x 2D scans, paid by scheme

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CANCER (ONCOLOGY):
Overall coverage (in and out of hospital):
  • R76,686 per family

Note: All oncology benefits are assessed on a case-by-case basis, and are subject to protocols, preferred providers and scheme rules. Benefit covers out-of-hospital treatment too, like chemotherapy.
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,338 R1,338 R427
Children: Pay for all children
Income limit: R7,101-R9,700 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

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DENTISTRY:
Dentistry:
  • Standard dentistry: R1,870 per person and R3,116 per family, with sub limits
  • Specialised dentistry: No benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,338 R1,338 R427
Children: Pay for all children
Income limit: R7,101-R9,700 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Orthodontics:
  • No benefit
Maxillo Facial Surgery:

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MEDICATION:
Chronic:
  • PMB chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,338 R1,338 R427
Children: Pay for all children
Income limit: R7,101-R9,700 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Acute (presrcibed) medication:
  • Limited to network providers and formularies
Over-the-counter:
  • Limited to network providers and formularies
Birth Control:
  • No benefit
On Discharge:
  • 7 days supply
Notes:
  • Chronic meds: Must be obtained from DSP. Formularies apply. Reference and GRP pricing apply

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OPTOMETRY:
Optometry:
  • Single vision: R1,046 per person incl frame, lenses and consult
  • Bifocal: R1,592per person incl frame, lenses and consult
  • Multifocal: no benefit
  • Contact lenses: no benefit
  • Every 2 years
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,338 R1,338 R427
Children: Pay for all children
Income limit: R7,101-R9,700 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

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MENTAL HEALTH:
In-hospital:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,338 R1,338 R427
Children: Pay for all children
Income limit: R7,101-R9,700 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:


Out-of-hospital:

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OTHER BENEFITS:
General Appliances:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,338 R1,338 R427
Children: Pay for all children
Income limit: R7,101-R9,700 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

1.1. Hearing Aids:
1.2. Wheelchairs:
Dialysis:
  • PMBs only, at network providers
HIV:
  • Covered at network hospitals if on HIV Management Programme
Emergency Transport: Netcare 911
International Coverage:
  • No benefit
Other:
  • Cochlear implants: no benefit

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WELLNESS/PREVENTATIVE BENEFITS:
Flu vaccination:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,338 R1,338 R427
Children: Pay for all children
Income limit: R7,101-R9,700 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Pneumonia vaccines:
Back Rehabilitation Programme:
Biometric Screening:
Child Immunisation:
Pap Smear:
  • Covered
Mammogram:
PAS Test:
  • Covered
HIV Test:
  • Covered

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PROSTHESIS:
Overal Limit:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,338 R1,338 R427
Children: Pay for all children
Income limit: R7,101-R9,700 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:
Sub-limits:

    Important!
  • Unless specified, assume that all benefits are paid are paid at 100% scheme rate
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • “Unlimited” benefits are still subject to authorisation, protocols and sublimits
  • Assume that all benefits need to be pre-authorised